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Low back pain (LBP) is amongst the top ten most common conditions presenting to primary care clinicians in the ambulatory setting. Further, it accounts for a significant amount of health care expenditure; indeed, over one third of all disability dollars spent in the United States is attributable to low back pain. In most cases, acute low back pain is a self-limiting disease. There are many evidence-based guidelines for the management of LBP. The most common risk factor for development of LBP is previous LBP, heavy physical work, and psychosocial risk factors.

腰痛（ LBP）是初级保健医生在门诊设置中十大最常见的情况。此外，它占了大部分金额的医疗保健支出;事实上，美国超过三分之一的残疾花销是由于腰痛。在大多数情况下，急性腰痛是一种自限性疾病。对LBP的管理很多证据为基础的准则。LBP的开发中最常见的危险因素是先前的枸杞多糖，做粗重工作和社会心理风险因素。

Management of LBP includes identification of red flags, exclusion of specific secondary causes, and comprehensive musculoskeletal/neurological examination of the lower extremities. In uncomplicated LBP, imaging is unnecessary unless symptoms become protracted. Reassurance that LBP will likely resolve and advice to maintain an active lifestyle despite LBP are the cornerstones of management. Medications are provided not because they change the natural history of the disorder, but rather because they enhance the ability of the patient to become more active, and in some cases, to sleep better.

LBP的管理包括识别红旗，排除特定的次要原因，和下肢肌肉骨骼综合/神经系统检查。在无并发症的枸杞多糖，成像是不必要的，除非症状变得持久。保证 LBP建议保持积极的生活方式，尽管LBP是管理的基石。所提供的药物不是因为它们改变疾病的自然历史，而是因为它们增强病人的更加活跃的能力，并且在某些情况下睡眠更好。

The most commonly prescribed medications include nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. Although NSAIDs are a chemically diverse class, their similarities, efficacy, tolerability, and adverse effect profile have more similarities than differences. The most common side effects of NSAIDs are gastrointestinal. Agents with cyclo-oxygenase 2 selectivity are associated with reduced gastrointestinal bleeding, but problematic increases in adverse cardiovascular outcomes continue to spark concern. Fortunately, short-term use of NSAIDs for LBP is generally both safe and effective. This review will focus on the role of NSAIDs in the management of LBP.

Keywords: low back pain, non-steroidal anti-inflammatory drugs, cyclo-oxygenase 2

Introduction 引言

Low back pain (LBP) is amongst the top ten most common reasons for a symptomatic visit to a clinician.1 LBP is also responsible for up to one third of all disability dollars spent in the United States. Hence, wise management of LBP is important to restore mobility, reduce pain, and if possible, diminish the likelihood of long-term disability. LBP is not solely a problem in the United States. Indeed, evidence-based clinical guidelines have been issued by many countries. Review of different clinical guidelines for the management of LBP revealed striking similarities in suggested diagnosis and management.2,3 Although there are numerous symptomatic treatments for LBP, the purpose of this review is to focus predominantly upon the role of nonsteroidal anti-inflammatory drugs (NSAIDs) in the management of LBP. Other treatments will be only discussed in passing.

Definitions and epidemiology 定义和流行病学

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